Scientific support for preparing an EU position in the 55th Session of the Codex Committee on Pesticide Residues (CCPR).

The European Commission asked EFSA to provide support in the framework of Article 43 of Regulation (EC) No 396/2005 for the preparation of the EU position for 55th Session of the Codex Committee on Pesticide Residues (CCPR). In the current report, EFSA provided comments and recommendations on the Codex maximum residue level (MRL) proposals derived by the Joint Meeting on Pesticide Residues (JMPR) that will be discussed in the upcoming CCPR meeting. The current report should serve as the basis for deriving the EU position for the CCPR meeting.

Scientific support for preparing an EU position in the 54th Session of the Codex Committee on Pesticide Residues (CCPR).

The European Commission asked EFSA to provide support in the framework of Article 43 of Regulation (EC) No 396/2005 for the preparation of the EU position for 54th Session of the Codex Committee on Pesticide Residues (CCPR). In the current report, EFSA provided comments and recommendations on the Codex maximum residue level (MRL) proposals derived by the Joint Meeting on Pesticide Residues (JMPR) that will be discussed in the upcoming CCPR meeting. The current report should serve as the basis for deriving the EU position for the CCPR meeting.

Extracorporeal Cardiopulmonary Resuscitation: A Narrative Review and Establishment of a Sustainable Program.

The rates of survival with functional recovery for out of hospital cardiac arrest remain unacceptably low. Extracorporeal cardiopulmonary resuscitation (ECPR) quickly resolves the low-flow state of conventional cardiopulmonary resuscitation (CCPR) providing valuable perfusion to end organs. Observational studies have shown an association with the use of ECPR and improved survivability. Two recent randomized controlled studies have demonstrated improved survival with functional neurologic recovery when compared to CCPR. Substantial resources and coordination amongst different specialties and departments are crucial for the successful implementation of ECPR. Standardized protocols, simulation based training, and constant communication are invaluable to the sustainability of a program. Currently there is no standardized protocol for the post-cannulation management of these ECPR patients and, ideally, upcoming studies should aim to evaluate these protocols.

Scientific support for preparing an EU position for the 52nd Session of the Codex Committee on Pesticide Residues (CCPR).

In accordance with Article 43 of Regulation (EC) 396/2005, EFSA received a request from the European Commission to provide support for the preparation of the EU position for 52nd session of the Codex Committee on Pesticide Residues (CCPR). In 2019, JMPR evaluated 20 active substances regarding the setting of toxicological reference values to be used in consumer risk assessment (acetochlor, boscalid, chlorothalonil, cyprodinil, dicamba, mesotrione, metaflumizone, thiabendazole, afidopyropen, buprofezin, clethodim, dimethoate, metconazole, omethoate, pyflubumide, pyridate, pyrifluquinazon, tolclofos-methyl, triflumuron, valifenalate) and 47 active substance regarding the setting of Maximum Residue Limits (MRLs) (acetochlor, azoxystrobin, boscalid, chlorantraniliprole, chlorothalonil, cyantraniliprole, cyprodinil, dicamba, fenazaquin, flonicamid, flupyradifurone, fosetyl-Al, glyphosate, mesotrione, metaflumizone, S-methoprene, pendimethalin, spirotetramat, tebuconazole, thiabendazole, acetamiprid, afidopyropen, benzovindiflupyr, bifenthrin, buprofezin, carbendazim, clethodim, cyclaniliprole, cypermethrins, dimethoate, fluazifop-p-butyl, fluensulfone, kresoxim-methyl, mandestrobin, metconazole, omethoate, penthiopyrad, picoxystrobin, pydiflumetofen, pyflubumide, pyrifluquinazon, pyriofenone, pyriproxyfen, tolclofos-methyl, tolfenpyrad, triflumuron, valifenalate). EFSA prepared comments on the Codex MRL proposals and the proposed toxicological reference values. In addition, EFSA provided the views on follow-up assessments of JMPR on pesticides where specific concerns were raised in the previous CCPR meetings. The current report should serve as the basis for deriving the EU position for the CCPR meeting.

ECPR-extracorporeal cardiopulmonary resuscitation.

Extracorporeal cardiopulmonary resuscitation (ECPR) is a salvage procedure in which extracorporeal membrane oxygenation (ECMO) is initiated emergently on patients who have had cardiac arrest (CA) and on whom the conventional cardiopulmonary resuscitation (CCPR) has failed. Awareness and usage of ECPR are increasing all over the world. Significant advancements have taken place in the ECPR initiation techniques, in its device and in its post-procedure care. ECPR is a team work requiring multidisciplinary experts, highly skilled health care workers and adequate infrastructure with appropriate devices. Perfect coordination and communication among team members play a vital role in the outcome of the ECPR patients. Ethical, legal and financial issues need to be considered before initiation of ECPR and while withdrawing the support when the ECPR is futile. Numerous studies about ECPR are being published more frequently in the last few years. Hence, keeping updated about the ECPR is very important for proper selection of cases and its management. This article reviews various aspects of ECPR and relevant literature to date.

Scientific support for preparing an EU position in the 51st Session of the Codex Committee on Pesticide Residues (CCPR).

In accordance with Article 43 of Regulation (EC) 396/2005, EFSA received a request from the European Commission to provide support for the preparation of the EU position for 51st session of the Codex Committee on Pesticide Residues (CCPR). In 2018, JMPR evaluated 15 active substances regarding the setting of toxicological reference values to be used in consumer risk assessment (chlorfenapyr, ethiprole, fenpicoxamid, fluazinam, fluxapyroxad, imazalil, kresoxim-methyl, lambda-cyhalothrin, mandestrobin, mandipropamid, norflurazon, pydiflumetofen, pyraclostrobin, pyriofenone, tioxazafen) and 27 active substances regarding the setting of maximum residue limits (MRLs) (abamectin, bentazone, chlorfenapyr, cyantraniliprole, cyazofamid, diquat, ethiprole, fenpicoxamid, fenpyroximate, fluazinam, fludioxonil, fluxapyroxad, imazalil, isofetamid, kresoxim-methyl, lufenuron, mandipropamid, norflurazon, oxathiapiproline, profenofos, propamocarb, pydiflumetofen, pyraclostrobin, pyriofenone, pyriproxyfen, sulfoxaflor and tioxazafen); EFSA prepared comments on the Codex MRL proposals and the proposed toxicological reference values. In addition, EFSA provided comments on follow-up assessments of JMPR on pesticides where specific concerns were raised in the previous CCPR meetings. The current report should serve as the basis for deriving the EU position for the CCPR meeting.

Scientific support for preparing an EU position in the 50th Session of the Codex Committee on Pesticide Residues (CCPR).

In accordance with Article 43 of Regulation (EC) 396/2005, EFSA received a request from the European Commission to provide support for the preparation of the EU position for 50th session of the Codex Committee on Pesticide Residues (CCPR). In 2017, Joint FAO/WHO Meeting on Pesticide Residues (JMPR) evaluated 15 active substances regarding the setting of toxicological reference values to be used in consumer risk assessment (bicyclopyrone, chlormequat, cyclaniliprole, fenazaquin, fenpropimorph, fenpyrazamine, fenpyroximate, fosetyl Al, isoprothiolane, natamycin, oxamyl, phosphonic acid, propylene oxide, thiophanate-methyl, triflumezopyrim) and 36 substances for deriving maximum residue limit (MRL) proposals (acetamiprid, azoxystrobin, bicyclopyrone, captan, chlormequat, cyclaniliprole, cyprodinil, 2,4-D, difenoconazole, fenazaquin, fenpropimorph, fenpyrazamine, fenpyroximate, flonicamid, fluensulfone, fluopyram, flupyradifurone, fosetyl Al, imazamox, imazapyr, imidacloprid, isoprothiolane, isopyrazam, natamycin, oxamyl, phosphonic acid, picoxystrobin, propiconazole, propylene oxide, prothioconazole, quinclorac, saflufenacil, spinetoram, tebuconazole, trifloxystrobin, triflumezopyrim); EFSA prepared comments on the Codex MRL proposals and the proposed toxicological reference values. In addition, EFSA provided the views on follow-up assessments of JMPR on pesticides where specific concerns were raised in the previous CCPR meetings. The current report should serve as the basis for deriving the EU position for the CCPR meeting, relevant findings are summarised in this report.

Scientific support for preparing an EU position in the 49th Session of the Codex Committee on Pesticide Residues (CCPR).

In accordance with Article 43 of Regulation (EC) 396/2005, EFSA received a request from the European Commission to provide support for the preparation of the EU position for 49th session of the Codex Committee on Pesticide Residues (CCPR). In 2016, JMPR evaluated 12 active substances regarding the setting of toxicological reference values to be used in consumer risk assessment (acibenzolar-S-methyl, fenpropimorph, fluazifop-P-butyl, fluensulfone, imazethapyr, isofetamid, oxathiapiprolin, penconazole, pendimethalin, pinoxaden, spiromesifen and teflubenzuron) and 24 active substance regarding the setting of Maximum Residue Limits (MRLs) (acibenzolar-S-methyl, benzovindiflupyr, bixafen, buprofezin, chlorantraniliprole, deltamethrin, dimethomorph, fipronil, fluazifop-P-butyl, fluensulfone, flupyradifurone, imazethapyr, isofetamid, methoprene, metrafenone, oxathiapiprolin, penconazole, pendimethalin, pinoxaden, saflufenacil, spiromesifen, sulfoxaflor, teflubenzuron and tolfenpyrad); EFSA prepared comments on the Codex MRL proposals and the proposed toxicological reference values. In addition, EFSA provided the views on follow-up assessments of JMPR on pesticides where specific concerns were raised in the previous CCPR meetings. The current report should serve as the basis for deriving the EU position for the CCPR meeting are summarised in this report.

The effect of extracorporeal cardiopulmonary resuscitation on prognosis of adult patients with cardiac arrest: meta-analysis / 中华急诊医学杂志

Objective To evaluate the effect of extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) on survival and neurological function in adult patients with cardiac arrest.Methods The PubMed and Web of Science were searched to collect relevant literature from Jan 1980 to Nov 2015,and two reviewers strictly distinguished the studies,assessed the quality of studies and picked up the valuable data for statistical analysis by using RevMan 5.0.Results A total of 8 studies involving 27 18 patients were included in our review.Of them,462 patients were treated with ECPR and 2 256 patients were cared with CCPR.The meta analysis showed that the survival discharge rate (OR =2.92,95％ CI:2.24-3.81,P ＜ 0.01),long-term survival rate (OR =2.97,95％ CI:2.11-4.19,P＜0.01) and neurological function status (OR=3.50,95％CI:2.36-5.81,P＜ 0.01) of ECPR (n =182) were better than those of CCPR (n =182).In 4 studies,propensity score matching was used to minimize bias and heterogeneity.The meta analysis also showed that the rate of ROSC,survival discharge rate,long-term survival rate and neurological function status in ECPR were superior over CCPR.Conclusions ECPR would be the excellent measures to improve ROSC rate,survival discharge rate,long-term survival rate and neurological outcome in adult victims with cardiac arrest.

Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: Conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation.

AIM: Refractory ventricular fibrillation, resistant to conventional cardiopulmonary resuscitation (CPR), is a life threatening rhythm encountered in the emergency department. Although previous reports suggest the use of extracorporeal CPR can improve the clinical outcomes in patients with prolonged cardiac arrest, the effectiveness of this novel strategy for refractory ventricular fibrillation is not known. We aimed to compare the clinical outcomes of patients with refractory ventricular fibrillation managed with conventional CPR or extracorporeal CPR in our institution. METHOD: This is a retrospective chart review study from an emergency department in a tertiary referral medical center. We identified 209 patients presenting with cardiac arrest due to ventricular fibrillation between September 2011 and September 2013. Of these, 60 patients were enrolled with ventricular fibrillation refractory to resuscitation for more than 10 min. The clinical outcome of patients with ventricular fibrillation received either conventional CPR, including defibrillation, chest compression, and resuscitative medication (C-CPR, n = 40) or CPR plus extracorporeal CPR (E-CPR, n = 20) were compared. RESULTS: The overall survival rate was 35%, and 18.3% of patients were discharged with good neurological function. The mean duration of CPR was longer in the E-CPR group than in the C-CPR group (69.90 ± 49.6 min vs 34.3 ± 17.7 min, p = 0.0001). Patients receiving E-CPR had significantly higher rates of sustained return of spontaneous circulation (95.0% vs 47.5%, p = 0.0009), and good neurological function at discharge (40.0% vs 7.5%, p = 0.0067). The survival rate in the E-CPR group was higher (50% vs 27.5%, p = 0.1512) at discharge and (50% vs 20%, p = 0. 0998) at 1 year after discharge. CONCLUSIONS: The management of refractory ventricular fibrillation in the emergency department remains challenging, as evidenced by an overall survival rate of 35% in this study. Patients with refractory ventricular fibrillation receiving E-CPR had a trend toward higher survival rates and significantly improved neurological outcomes than those receiving C-CPR.

Educación en reanimación básica: Qué tanto y cómo se aprende / Education in basic resuscitation: How much and how you learn

Las guías en Reanimación propuestas por la Sociedad Americana del Corazón enfatizan en la necesidad del correcto aprendizaje e implementación de las técnicas, habilidades y conocimientos en reanimación cardiocerebropulmonar básica como base fundamental y como determinante principal en las tasas de morbimortalidad de los pacientes que se presentan con paro cardiorrespiratorio. De igual manera plantea un verdadero reto para el personal lego y personal relacionado con el área de la salud que actúan como primeros respondientes en la atención de estos pacientes, y que hace necesario que se conozcan y se apliquen de manera optima los procedimientos propuestos por la Sociedad Americana del Corazón. Esto a su vez implica que este personal debe tener un adecuado entrenamiento para la adquisición de habilidades y destrezas correctas y además, que perduren en el tiempo, y es allí, donde la educación en reanimación juega un papel muy importante a través de la formación teórica y practica, mediante grupos operativos de trabajo que guíen el aprendizaje, y el uso de tecnología en simulación que permite la retroalimentación de los procedimientos aprendidos. Es indispensable entonces, el conocimiento y evaluación de las tasas de efectividad de los diferentes cursos en Reanimación diseñados, y de especial interés el ofrecido por el comité de Reanimación de la Sociedad Colombiana de Anestesiología y Reanimación en donde actualmente se lleva a cabo un estudio en investigación para determinar la efectividad en el aprendizaje e identificar las posibles debilidades que puedan mejorarse y ofrecer así educación de alta calidad .

The resuscitation guidelines proposed by the American Heart Association (AHA) emphasize the need for a proper learning and implementation of techniques, skills and knowledge regarding basic cerebral cardiopulmonary resuscitation as a fundamental basis and principal determinant of morbidity and mortality rates of patients presenting with cardio respiratory arrest. Likewise, the AHA`s guidelines state a truly challenge for the non expert (lego or non health care professional) persons and health care related workers, who are the first responders in the medical care process of these patients; this situation generates the need for the knowledge and optimal implementation of the procedures proposed by the American Heart Association. This in turn implies that these personnel must have adequate training to acquire correct skills and abilities, which endure over time, and it is there, where the education in resuscitation plays a very important role across the theoretical and practical training, working through task forces that guide the learning and the use of simulation technology that allows a feedback process of the procedures learned. It is essential then, the knowledge and assessment of the effectiveness rates in the different designed courses of Resuscitation, and the special interest offered by the committee of Resuscitation of the Colombian Society of Anesthesiology and Resuscitation where is currently carrying out a study of investigation to determine the effectiveness in learning and identifying the potential weaknesses that can be improved and so provide high quality education .

Results of a CCPR Intercomparison of Spectral Irradiance Measurements by National Laboratories.

An intercomparison of spectral irradiance measurements by 12 national laboratories has been carried out between 1987 and 1990. The intercomparison was conducted under the auspices of the Comité Consultatif de Photometrie et Radiometrie (CCPR) of the Comité International des Poids et Mesures, and the National Institute of Standards and Technology (NIST) served as the pilot laboratory. The spectral range of the intercomparison was 250 to 2400 nm and the transfer standards used were commercial tungsten-halogen lamps of two types. The world-wide consistency of the results (one standard deviation) was on the order of 1% in the visible spectral region and 2 to 4% in the ultraviolet and infrared portions of the spectrum. The intercomparison revealed no statistically significant differences between spectral-irradiance scales based on blackbody physics and absolute detector radiometry.